Examples of Completed Applications - Queen's Nursing ...

Examples of Completed Applications

For many years now nursing education has been based on reflective practice and this is the basis of questions 2 & 3 of the Queen's Nurse application form. If you have undertaken the new NMC revalidation process you may well have reflective accounts which you can use. It was suggested that potential applicants might find it helpful to read some examples of completed questions. We have asked four of those who applied for 2017 if they would be willing to have their applications shared so others could see what a good answer might look like. Whilst names have been removed we have not been able to fully disguise the identities of those who wrote them. Please treat the information with sensitivity.

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Example 1 ? Criminal justice nursing

2. IN SUPPORT OF YOUR APPLICATION ? please read the excellence

profile in the guidance document and give us examples from your nursing practice of how your expertise matches the areas below.

How have you made a difference?

changing how things are currently done, making things better for individuals, families and communities

and/or helping others to make a significant impact.

I was `made' the first senior charge nurse in police custody healthcare in Scotland. This was a significant challenge! The changes I made initially were to change the focus of care from power /coercive to a person centred model which allowed the nursing staff to deliver care at the right time for the patient. I introduced PGDs and was able to get all staff enrolled on to a non medical prescribing course. Working with other agencies I made it clear that Police Custody would not be used as a place of safety and trained the nursing staff to undertake mental health assessments which allowed patients a timely and proactive assessment and so could leave custody.

I introduced drug testing and breath alcohol testing in order to inform treatment choices and changed the practice ethos from treating withdrawal symptomatically to a withdrawal prevention treatment regime. This had the effect of reducing patient referral to ED, and all the associated harms of drug and alcohol withdrawal. This also helped the general emotional well being of patients in custody and the general work environment. I worked with Support in Mind to highlight the needs of people in custody with mental health problems and a publication of case studies was produced with funding from NHS Lothian. Part of the task was to get other agencies involved in what we do and I gave countless talks to universities, NHS staff, Custody visitors, Council workers, medical staff, prison staff, police etc. I was part of the Faculty of New to Forensic Medicine that designed and implemented a teaching programme funded by Government through NES to all doctors and nurses working in this field across Scotland. This was as a part of the transfer of healthcare responsibility from Police to NHS Boards in 2014.

The service is now a nurse led service. Working with senior management, we implemented a virtual call centre, a software system, with all the required governances to receive referrals from the SE of Scotland. We recruited a further 25 nurses and I developed a training and implementation plan for them as they bedded in to their new teams in the region with 2 new senior charge nurses who had never worked at this level before .I was chosen to be profiled in the campaign `Nursing on the Edge' by RCN Scotland which showcased the service and nursing in this field as a real career choice where patients really need their help and expertise. As a result, I was asked to speak at two events at the Scottish Parliament regarding this project and also at a cross party steering group for mental health. The contacts made during these events has been invaluable, our profile has been raised and our service attracts a great deal of interest. During this time, I worked with Edinburgh Napier University to create a student placement which has been very well received by all. I have been published a few times and delivered a paper about NPS internationally and have recently been voted to become the Chair of the RCN Criminal Justice and Forensic Nursing Steering Committee. All of the above came from a heartfelt and unshakeable belief that my patients deserved the best equivalence of care as they so often did not have a voice to ask for it. Health inequality ruins lives and families and creates a long shadow over the future and I saw it as my task to reduce these for my staff, service and patients.

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Example 1 ? Criminal justice nursing

How have you demonstrated your tenacity and resilience?

finding your way across boundaries, around obstacles, through bureaucracy successfully challenging attitudes

finding new doors to open each time one closes.

I have been lucky as I have worked in many areas of nursing before I came to police custody and forensic examination. I have got to know people on the way and there is an interdependence in those relationships that can really help to push the agenda forward. I have never been afraid of asking for help, or listening to it. When I was approached for this role, I knew that I was very well prepared to tackle it professionally, emotionally and personally. I was prepared to be unpopular, which is difficult as old relationships could be changed out of all recognition, but I knew that change comes with conflict ? thankfully- there have been no serious casualties during the process. My ethos was to treat staff as registered, autonomous and professional nurses. I expected them to want to be highly qualified and work to a very high standard. I also undertook the same training and improved my own practice. I was able to work with staff side unions to protect contracts during change management and give staff the security that they needed in return.

Working with the Police has been largely supportive, understanding how each juggernaut of the public sector- NHS and police- deal with risk and making safe the interface has been my task and that has been done. There are often differences of approach, but working together has reduced deaths in custody, near misses in custody and the general safety of all concerned.

Working across boundaries has been of great interest, I enjoy meeting and working with other people and agencies and work in a very open way. I think that this is attractive to others and people are happy to build supportive networks wherever they come from. I have shared information with services just starting up and I have been honest about the challenges that we face. I always link this to the `bigger picture' and in my case- I always referred back to a Ms Angela Smith who died in police custody in Edinburgh in 2008. The recommendations from her fatal accident inquiry have been implemented and this is a mark of respect for her and her family. I believe that nobody should breathe their last breath locked up in a cell whilst waiting to go to Court. Especially if it is preventable. I have been fearless in saying this and putting my professional reputation at the feet of this statement. If we know how to deliver evidence based healthcare- then we must.

I was determined and happy to remove those obstacles. I was called `charming' by my head teacher in my undergraduate nursing application, which I am not sure was a compliment, but I decided that it was at least evidenced so decided to use my friendliness and natural curiosity as an asset. People find me open, friendly and helpful. And resilient. I am glad that I am a trusted practitioner and I think this is at the heart of breaking through and changing things for the better.

Compassion is hard to talk about, but you do need to care in order to change services for the better- not just for you or your staff, but for our patients. This involves being criticised, righting wrongs and a big dose of humility. Sometimes you have to be prepared to let go and allow others to take up the mantle in order to replicate good practice. There are few things that you own in life, and success is definitely not yours to keep!

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Example 1 ? Criminal justice nursing

How have you brought people with you?

using your enthusiasm and persuasive nature creating a ground swell of support and recognition that has "carried the day" getting others to commit and get things done.

I have been fortunate in the team and directorate within which I work. There is a structure around us and expectations to fulfil. We try and work with a consensus direction of travel. This can be dictated to by prevailing conditions, not least of which are financial constraints.

Bringing other people with you is more of an art form than a science! It is a mixture of persuasion, committment and fitness for purpose. One of my strengths is seeing the links between the needs of different people, different services and what we have in common. Often we have very similar objectives and we can share ideas, solutions and introductions.

As a result of taking up this position, being selected for the RCN `Nursing on the Edge' campaign, working with the Faculty of New to Forensic Medicine, and the RCN Nursing in Criminal Justice Forum and the Network Board in Scotland for Police custody healthcare as well as having been in position from 2012 as SCN, I became the `go to ` nurse for this practice area ? of course this is diluted and shared over time as new colleagues come along and they find their own voce in practice.

Speaking at RCN Congress in 2015 about the needs of people in police custody resulted in an interview with The Scotsman newspaper which attracted positive praise from the editorial and Police Scotland. In particular, I focussed on the changes in practice as the result of a death in custody- this was conveyed with honesty and clarity which I think relaxes people and allows people to see the real human reasons we are doing what we are doing. I was trending on Twitter for about ten minutes!!!

Doing interviews, speaking at Parliament, getting up in front of 2000 people at Congress has been very much out of my comfort zone as a registered nurse. However, to bring people with you, you have to be brave and offer the potential of working in an amazing cutting edge team that is making a huge difference to the most sidelined people in our society who are ill and in crisis. I needed strong, resilient and compassionate nurses in my team, and you have to demonstrate that as a leader you are clearly stating your principles so that you are understood. This is the cornerstone of my practice, I will lead and share the successes, I will support and protect my staff and colleagues and this is all to deliver the best healthcare to our patients. This protects the reputation of nursing and NHS Lothian. I do expect performance in return. People want to be associated with success and have to be empowered to be the best that they can be.

At times, it can be tough to keep that enthusiasm going, there are always going to be setbacksunexpected blockades from partner agencies, staff sickness , serious illness in your own family ? ordinary life in other words. That is where the benefits of having a wide and supportive network are most valued- you will get help, you will get favours and you will get a boost in energy from those around you. Never underestimate the power of humour in this world!

I remember a Police Inspector saying to me after a particularly bruising period of change within our service- `The captain of the ship- the loneliest seat on the boat'. However true this is, you also get the best view!

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Example 1 ? Criminal justice nursing

How have you demonstrated your ability to reflect?

listening deeply, seeking to understand what really matters. approaching life reflectively, always learning and kind to self. quick to attribute success to others and not seek credit for things.

Some of the management structures allow a person to reflect. Within NHS Lothian, I have been on a Delivering Better Care course and a Leading Better Care course including on for BME staff managers. I also undertake clinical supervision myself and as a supervisor. One of the hardest things that I find is instilling within nurses that they can enjoy success and achievement. During an initial period of change, one nurse was particularly resistant to change and many hours were spent in conversation with him to get to the root of his resistance. He did , in fact, become an early adopter and through a period of study became a nurse prescriber and completed a nursing degree after 25 years' service, the first person in his family to get a university degree. He was incredibly proud of this. Having the first student nurse coming on placement to Police custody nursing was good for all the staff, they could showcase their expertise, and this had some function of consolidating their experience. The student nurse, the mentor and myself wrote a piece about her experience that was published in the nursing pressthis too was a happy day!

Using the lessons learned that we had as nurses in last year's Novel Psychoactive Substances crisis, which united our staff though lived experience and action, I was able to speak about it at a conference in Canada. I received funding from the RCN Foundation- I had mixed feelings about this trip. I did feel like an impostor, and this was too much and luxurious for a nurse. I decided that as I was there, I needed to embrace this experience. I listened to nurse academics and practitioners from all over the world. Many with a whole career in `correctional' nursing behind them. What I learned from them was invaluable. I felt enriched once I had given myself permission to be there!

On return, I wanted to offer staff an away day to build the team further and talk about vicarious trauma. I also wanted them not to be afraid of feedback- giving or receiving. This investment proved worthwhile as it bonded the team who had never had the opportunity to be all together in one place for the day. I had booked a consultant mentalisation and trauma doctor to speak, the deputy chief nurse and a Scotland Rugby International and sporting leader who had prepared the Scotland squad for the recent Commonwealth Games. All gave their services and time for free. As did the venue. We now talk about our feelings regarding the work that we do. I wrote an article for the British Journal of Nursing about creating a professional identity for police custody nursing. I wanted to help to allow us to establish an esprit de corps in our speciality to create a pride and belonging in what we do.

I know that I won't win everybody round, and there is cynicism that can slow progress down and burn people out when they are already stressed, but I have found from the advice of the senior nurses that as soon as they see you disappearing around the corner- most will increase their pace to catch up. We like our teams and even the lone wolves are part of that camaraderie and expertise.

Professionalism and self respect are vital in building resilience in your role. I have learned from others to introduce myself to patients saying may name and title and that I am a registered nurse and start the consultation process from there. It really helps the patient know where we are, and what relationship that we have and what they can expect.

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